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Effect of recommended positioning on stroke outcome at six months: a randomized controlled trial

Florence Nightingale School of Nursing & Midwifery, London, UK

K Tilling

Department of Public Health, King's College London; Department of Social Medicine, University of Bristol, London, UK

J Wilson-Barnett

Florence Nightingale School of Nursing & Midwifery, London, UK

D J Newham

Centre for Applied Biomedical Research, School of Biomedical Sciences, London, UK

C DA Wolfe

Department of Public Health Sciences, King's College London, London, UK

Objective: To evaluate the effect on patient outcome of a teaching package for nurses designed to improve the positioning of stroke patients.

Design: Cluster randomized controlled trial with six-month follow-up.

Setting: Ten stroke rehabilitation hospital units located within one UK inner city region. These were randomized to control or intervention group.

Subjects: A sample of 120 patients admitted within four weeks of a first stroke and with a hemiplegia. No eligible patient refused to participate. Eighty-three (69%) completed the study.

Intervention: All nursing staff on the intervention units received a group teaching package to improve their clinical practice in patient positioning.

Main outcome measure: Rivermead Mobility Index (RMI) at six months post stroke. Patient's position was recorded using an established observational tool.

Results: After the teaching there was some evidence of better positioning in the intervention than the control group (difference in percentage of correct positions per patient 4.9%, 95% confidence interval (CI-0.1% to 9.9%, p-0.055). There was no evidence of differences between the two groups in any of the outcome measures at six months although there was a trend towards increased elbow flexor tone in the control group.

Conclusions: A teaching intervention to improve patient positioning made no significant impact on outcome at six months post stroke. However, following the teaching there was only a slightly higher incidence of recommended patient positioning within the intervention group. Thus, a teaching package may not be powerful enough to enable any effect on patient outcome to be measured.

Clinical Rehabilitation, Vol. 19, No. 2, 138-145 (2005)
DOI: 10.1191/0269215505cr855oa


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